ABSTRACT
Para interpretar correctamente los estudios radiológicos de una cadera dolorosa se requiere conocer detalladamente la anatomía regional. Algunas variantes del fémur proximal, como las deformidades tipo cam, pueden cursar de forma asintomática o causar un síndrome de choque femoroacetabular. El ángulo alfa, principal exponente numérico de estas deformidades, tiene algunas limitaciones. Nuestro objetivo es revisar las variantes anatómicas en la vertiente anterior del fémur proximal, centrando la atención en las deformidades tipo cam. Describimos los parámetros útiles para caracterizarla con métodos de imagen, utilizando diagramas e imágenes de tomografía computarizada multidetector. Exponemos además la correspondencia potencial de las deformidades tipo cam con términos descriptivos previamente acuñados por anatomistas y antropólogos (AU)
Interpreting imaging studies of a painful hip requires detailed knowledge of the regional anatomy. Some variants of the proximal femur, such as cam-type deformities, can course asymptomatically or cause femoroacetabular impingement. The principal numerical criterion for defining cam-type deformities, the alpha angle, has some limitations. In this article, we review the anatomic variants of the anterior aspect of the proximal femur, focusing on cam-type deformities. Using diagrams and multidetector CT images, we describe the parameters that are useful for characterizing these deformities in different imaging techniques. We also discuss the potential correspondence of imaging findings of cam-type deformities with the terms coined by anatomists and anthropologists to describe these phenomena (AU)
Subject(s)
Humans , Hip Joint/anatomy & histology , Arthralgia/etiology , Anatomic Variation , Femoracetabular Impingement/diagnosis , Multidetector Computed Tomography/methods , Magnetic Resonance Spectroscopy/methodsABSTRACT
Interpreting imaging studies of a painful hip requires detailed knowledge of the regional anatomy. Some variants of the proximal femur, such as cam-type deformities, can course asymptomatically or cause femoroacetabular impingement. The principal numerical criterion for defining cam-type deformities, the alpha angle, has some limitations. In this article, we review the anatomic variants of the anterior aspect of the proximal femur, focusing on cam-type deformities. Using diagrams and multidetector CT images, we describe the parameters that are useful for characterizing these deformities in different imaging techniques. We also discuss the potential correspondence of imaging findings of cam-type deformities with the terms coined by anatomists and anthropologists to describe these phenomena.
Subject(s)
Anatomic Variation , Femur Head/anatomy & histology , Femur Head/diagnostic imaging , Hip Joint/anatomy & histology , Hip Joint/diagnostic imaging , Multidetector Computed Tomography , Adult , Aged , Femur Head/abnormalities , Hip Joint/abnormalities , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Many studies have estimated observer variability for optic disc assessment among experts, but there are few data on agreement between optometrists and ophthalmologists. The aim of this study is to report inter- and intraobserver agreement among optometrists and ophthalmologists in optic disc assessment and discuss the implications for glaucoma co-management. METHODS: Twelve observers (six optometrists and six ophthalmologists) graded 48 stereo-pairs of optic disc photographs from 48 patients on two separate occasions. Observers graded the vertical C/D ratio, the narrowest rim width and the presence/absence of disc haemorrhage. Agreement was assessed by calculating the standard deviation (SD) of differences and the kappa statistic, within and between observers. Systematic differences in grading between and within individuals were described by calculating mean differences. RESULTS: Intra-observer agreement is "substantial" and significantly better than inter-observer agreement for all disc features (P<0.0001). Intra-observer agreement is comparable for optometrists and ophthalmologists with regard to C/D ratio estimates. Although some optometrists show close agreement with ophthalmologists, overall agreement between optometrists and ophthalmologists is significantly worse than agreement among ophthalmologists alone for vertical C/D ratio (P=0.002) and disc haemorrhage (P=0.02). There are fewer inter-observer mean differences that differ significantly from zero among ophthalmologists (7%) than among optometrists (67%; chi2=11.63, P<0.001) or between optometrists and ophthalmologists (69%; chi2=16.7, P<0.001). There is evidence of systematic under-reading of C/D ratios by less experienced optometrists. CONCLUSION: Although individual optometrists can show good agreement with ophthalmologists on disc grading, the variation in individual performance indicates that training and accreditation in disc assessment is an essential prerequisite for participation by optometrists in glaucoma co-management.
